Instructions For Dd Form 1351-2
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1INSTRUCTIONS FOR DD FORM 1351‐2
Leave all shaded boxes blank.
X
CIV
X
Leave blank if not
available.
Enter one of the following
codes into each of the
white boxes
TRICARE Regional Office - West
corresponding to filled‐in
“DEP” (departure) rows:
PA – Drove an automobile
to the appointment.
Date of trip
departure
CP – Purchased your own
commercial carrier ticket,
2009
RESIDENCE CITY, STATE
and flew to the
Dates of arrival at
appointment.
and departure from
DESTINATION CITY, STATE
Destination City
MC
RESIDENCE CITY, STATE
Date arrive
back home
Use instructions for
15d. on the back of DD
Indicate “Own/Operate” or
Form 1351‐2 to enter
“Passenger” only if a personal
the appropriate code
vehicle or rental car was driven.
into each white box
corresponding to
filled‐in “ARR” rows.
For Patient or
Lodging
Civilian NMA:
Use code TD for period
Lodging Taxes
Enter totals from
of treatment, and MC
Meals
DD Form 1351‐3
Fuel
for arrival back home.
under “AMOUNT”
Airfare
Local Transportation
in column 18c.
Indicate the duration
Other
of your trip.
Sign and Date
Revised 8/31/11
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